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U. P. DENTAL COUNCIL
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Student Registration Panel ( Provisional Registration )
Candidate Details
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Registration Part in Name
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Title
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SRI.
SMT.
KM.
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First Name
Middle Name
Last Name
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Father's Name
Gender
Male
Female
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Mother's Name
*
Religion
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Hindu
Muslim
Sikh
Christian
NA
*
Permanent Address
*
Date Of Birth
*
Country
India
*
State
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*
District
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*
Pincode
*
Mobile No
*
Aadhaar No
*
Email-ID
Course Details
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Course
B.D.S.
*
University
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*
College
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*
Year of Joining
--Select Month--
January
February
March
April
May
June
July
August
September
October
November
December
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Year Of Passing
--Select Month--
January
February
March
April
May
June
July
August
September
October
November
December
RollNo
*
University Enrollment
No
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I here certify that the information furnished in this application is true to the best of my knowledge and belief. My Application/Registration may be rejected/cancelled, if any information provided herein is found to be incorrect or fake at any time during or after the submission of form. I understand that the U.P. DENTAL COUNCIL is not responsible for any inadvertent error that may have crept in the application being filled online over the internet.
मैं एतद्द्वारा प्रमाणित करता / करती हूँ की इस आवेदन में दी गयी समस्त जानकारी मेरे ज्ञान और विश्वाश के अनुसार सही है | किसी भी समय अगर गलत सूचना पायी जाती है तो मेरा आवेदन/रजिस्ट्रेशन निरस्त कर दिया जाये | मैं समझता / समझती हूँ की उ० प्र० डेंटल कौंसिल किसी भी अनजान त्रुटि के लिए जिम्मेदार नहीं है जो इंटरनेट पर ऑनलाइन भरे जाने वाले आवेदन में शामिल हो सकती हैं |
